NATIONAL PRIMARY ORAL HEALTH CARE CONFERENCE 2011 CELEBRATING NNOHA S 20TH ANNIVERSARY. October 25, 2011 GAYLORD HOTEL NATIONAL HARBOR,MD

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1 NATIONAL PRIMARY ORAL HEALTH CARE CONFERENCE 2011 CELEBRATING NNOHA S 20TH ANNIVERSARY October 25, 2011 GAYLORD HOTEL NATIONAL HARBOR,MD 1

2 WELCOME TO HIT SESSION MEANINGFUL USE (MU): WHAT DOES MU MEAN TO US? PRESENTERS: DR. YAEL HARRIS, HRSA DR. JANET LEIGH, HRSA DR. STEVEN GLENN, ADA DR. HUONG LE, NNOHA 2

3 NNOHA MISSION STATEMENT To improve the oral health of underserved populations and contribute to overall health through leadership, advocacy, and support to oral health providers in safety-net systems. Chart Number 3

4 NNOHA HIT ACTIVITIES November 2008: Published HIT White Paper - Guide to the Future: Using HIT to Improve Oral Health Outcomes Committee members : Maggie Drozdowski-Maule, Clifford Hames, Lohring Miller, Huong Le July 2011: Received HRSA funding for NNOHA s HIT initiative October 2011: Selection of Meaningful Use Measures and Update HIT White paper 4

5 NNOHA HIT & MU WORK GROUP 2011 Huong Le, DDS NNOHA Chair of HIT & MU Committee Colleen Lampron, MPH NNOHA Mitsuko Ikeda NNOHA Irene Hilton, DDS NNOHA Steven Russell, MEEM, MSHA, CPHIT NNOHA HIT and MU Consultant, Strategic Interests Amanda Stangis, MPH California Primary Care Association Andie Martinez Patterson, MPP California Primary Care Association Maggie Drozdowski-Maule, DMD Community Health Center Inc., CT Lyn Blankenship Community Health Centers Inc., Fl Clifford Hames, DDS Hudson River HealthCare, NY Karen Dent, CDA, EFDA Missouri Primary Care Association Ryan Krull Missouri Primary Care Association Noelle Parker Missouri Primary Care Association Sonia Sheck Colorado Community Health Network Shannon Quirk Mass League of Community Health Centers Terry Russell New York State Oral Health Coalition 5

6 NNOHA MU WORKGROUP Reviews process to qualify for financial incentive for the Meaningful Use (MU) of certified EHR technology Includes review of core and menu set objectives, exclusions, reporting and attestation Recommends Clinical Quality Measures for Oral Health Includes 6 total clinical quality measures for dentists 3 core measures (3 alternate core measures where necessary) Additional CQMs recommended for the 3 remaining measures 6

7 NNOHA HIT COMMITTEE Update the GUIDE TO THE FUTURE white paper Includes an analysis of the different EDR/EHR products currently available to Health Centers Create an analysis tool to guide the selection of an EDR/EHR Includes a multi-step process for selecting an EDR/EHR solution, A guide to determine eligibility for the Medicare/Medicaid EHR incentive programs, an assessment of MU criteria and CQMs for oral health, and A review of EDR/EHR vendor support for implementing MU clinical quality measures for oral health programs Chart Number 7

8 WHAT IS THE MEANINGFUL USE (MU) FRAMEWORK? The National Quality Forum released a report titled National Priorities and Goals which were used to create the framework for Meaningful Use Meaningful Use is a term defined by CMS and describes the use of HIT that furthers the goals of information exchange Improve quality, safety, efficiency and reduce health disparities Engage patients and families Improve care coordination Ensure adequate privacy & security protections for personal health information Improve population and public health 8

9 WHAT ARE THE MEANINGFUL USE OBJECTIVES? Use of certified EHR in a meaningful manner Use of certified EHR technology for electronic exchange of health information to improve quality of health care Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary 9

10 MEANINGFUL USE MULTI-STAGE PROCESS Meaningful Use is a multi-stage process to cost-effectively improve the quality of healthcare in the US A key step in the process is adoption of a certified EDR/EHR to replace paper records 10

11 CMS EHR INCENTIVE PROGRAMS Medicare Program Medicaid Program Must be a physician - defined as MD, DO, DDM/DDS, optometrist, podiatrist, chiropractor Must have Part B Medicare allowed charges Must not be hospital-based Must be enrolled in PECOS Living Not hospital-based = <90% services furnished in inpatient or ED setting Must be one of 5 types of EPs Have 30% Medicaid patient volume - or - practice predominantly in an FQHC or RHC with 30% needy individual patient volume Licensed, credentialed Not on the Office of Inspector General Exclusions List Living Cannot be hospital-based 1. Child Health Plus does not count in patient volume calculation 2. Needy = Medicaid, uninsured, free care, patients in sliding scale programs 11

12 MEANINGFUL USE EHR INCENTIVES A STRATEGIC INVESTMENT Medicare Incentives Medicaid Incentives Up to $44,000 over 5 years Up to $63,750 over 6 years Payments are proportional to Medicare billings (75% of total billings up to a cap each year, including capitation and copayments) Payments increased by 10% for physicians practicing in a HPSA Must participate by 2012 to receive the maximum incentive payment Payments are fixed and not proportional to Medicaid billings If pediatricians qualify at 20%, only eligible for 67% (2/3) of payments Must participate by

13 REPORTING REQUIREMENTS Reporting is through attestation Providers will fill in numerators and denominators for the meaningful use objectives and CQMs Indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use Medicare EPs Year 1: Must report utilization of certified EHR technology on 90 consecutive days Subsequent Years: Must report utilization for a full 12 months Medicaid EPs Year 1: No requirement to report on implementation or upgrade; must report on costs of acquisition Year 2: Must report utilization for 90 consecutive days Subsequent Years: Must report utilization for a full 12 months Medicaid providers are not required to report on consecutive years until 2017/FFY1 13

14 NNOHA s Proposed CQMs for Oral Health 9/17/2013 Core Set Measures Numerator Denominator 1. Annual Oral Health Visit - Percentage of patients who had at least one dental visit during the measurement year. 2. Topical Fluoride or Fluoride Varnish Treatment - Percentage of patients age 14 years and younger with at least one topical fluoride treatment or fluoride varnish treatment documented. 3. Dental Sealant - Percentage of patients age 6 to 20 years that received an appropriate sealant treatment on 1st and 2nd permanent molars. 4. Oral Cancer Risk Assessment & Counseling - Percentage of all patients who receive soft tissue screening, oral cancer exam and counseling. 5. Periodontal Disease Assessment - Percentage of patients age 18 years and older who have been screened for the presence of periodontal disease. 6. Completed Comprehensive Treatment Plan - Percentage of all dental patients for whom the Phase I treatment plan is completed within a 12 month period. Numerator: The number of patients with one or more dental visits. Numerator: The number of patients age 14 years and younger with at least one topical fluoride or Fluoride Varnish treatment (ADA code 1203). Numerator: The number of patients age 6 to 20 years that received an appropriate sealant treatment on 1st and 2nd permanent molars. Numerator: The number of patients who receive soft tissue screening, oral cancer exam and counseling. Numerator: The number of patients age 18 years and older who have been screened for the presence of periodontal disease. Numerator: The number of patients with a completed Phase 1 treatment within 12 months of initiation. Denominator: The total number of registered patients at the health center. Denominator: The number of patients age 14 years and younger who receive a comprehensive oral health exam (ADA code 0110) or a periodic recall (ADA code 0120) oral health exam during the report period. Denominator: The number of patients age 6 to 20 years who receive a comprehensive oral health exam (ADA code 0110) or a periodic recall (ADA code 0120) oral health exam during the report period. Denominator: The number of patients who receive a comprehensive oral health exam (ADA code 0110) or a periodic recall (ADA code 0120) oral health exam during the report period. Denominator: The number of patients age 18 years and older who receive a comprehensive oral health exam (ADA code 0110) or a periodic recall (ADA code 0120) oral health exam during the report period. Denominator: The number of patients that receive a comprehensive oral health exam (ADA code 0110) or a periodic recall (ADA code 0120) oral health exam during the report period. 14

15 PROCESS FROM OUTCOME MEASURES TO MEANINGFUL USES Collaboration with HRSA & ADA on CQMs Submit Proposed CQMs to National Quality Forum (NQF) Measure has to be tested and studied Approval process NQF number assigned 15

16 WHITE PAPER UPDATE September 2011 Four EDR/EHR vendors selected based on the level of health center market penetration and MU participation QSI EDR and NextGen EHR Dentrix Enterprise Open Dental Mediadent Vendor survey and RFI was developed and responses reviewed Product web-based product demonstrations Vendor and product evaluations: scored by vendors and HIT members First white paper draft completed 16

17 FUTURE ACTIVITIES Publish updated Guide to Future white paper An EDR/EHR and MU resource to NNOHA members Collaboration with HRSA, ADA, Dental Quality Alliance and CMS to provide updates to membership THANK YOU FOR YOUR SUPPORT STAY TUNED! 17